Setting AAOS Now Straight

‘Inappropriate’ transfers and ‘inconvenient’ services
As an orthopaedic surgeon participating in general unassigned call at a level 1 trauma center, I found that the article regarding transfers for minor problems (AAOS Headline News Now, Jan. 25, 2008: “Study finds patients with minor injuries transferred to trauma centers”) barely touches the magnitude of this problem.

It is not uncommon for me to find that patients from distant hospitals arrive at our facility after bypassing facilities that refuse (“are unable”) to provide orthopaedic care. Transfers for reasons such as “I don’t do infections,” “I don’t care for periprosthetic fractures,” “We don’t have the equipment for care of long bone fractures,” or even “They might be in the hospital for longer than a day, and I don’t do hospital care” have become the norm. This does not include transfers because “there is no specialty call coverage for our facility tonight.”

During the recent holiday season, I found myself providing on-call orthopaedic coverage for seven peripheral hospitals (distance of 1 to 3½ hours away, in- and out-of-state) that “had no ortho call,” even though those hospitals provide elective inpatient and outpatient orthopaedic services on a routine basis.

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